SITE INFORMATION AND CORRESPONDENCE

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Runby :.SANDY San Joaquin County PHS/EHD Report #5021 FACILITY INFORMATION as of 08/04/98 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Make changes/corrections in RED pen or pencil: OWNER FILE INFORMATION INFORMATION CHANGE (date): OWNERSHIP CHANGE (date): OWNER ID: 006381 New Owner ID: 00 Owner Name: STOCKTON PORT DISTRICT Owner DBA: HYDRO-AGRI Owner Address: PO BOX 2485 LOS ANGELES, CA 90051 Home Phone: Soc Sec# / Tax ID#: Ownership Type: 01 CORPORATION Mailing Address: PO BOX 2485 care of: STOCKTON PORT DISTRICT LOS ANGELES, CA 90051 FACILITY FILE INFORMATION FACILITY ID: 007724 Facility Name: HYDRO-AGRI Location: 3 019 NAVY DR STOCKTON 95201 Phone: Mailing Address: 3 019 NAVY DR 10D 9-- �3Ark `9tcare of: HYDRO-AGRI STOCKTON, CA 95201 Location Code: APN: BOS District: SIC Code: ACCOUNTS RECEIVABLE FILE INFORMATION ACCOUNT ID: 0013420 New Account ID: 000 Mail Invoices to: Facility Mail Invoices to: Owner / Facility / Account Account Name: HYDRO-AGRI (Circle one) Account Balance as of 08/04/98 : $0 . 00 (Circle one) Record UST(s) Transfer to Activate / Inactivate P/E Description ID Employee Status Linked new owner? Delete - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2950 ENVIRON ASSESS PR507169 0684 INFURNA INACTIVE Y N A I D - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - BILLING and COMPLIANCE ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or project specific PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on this form. I also certify that all operations will be performed in accordance with all applicable SAN JOAQUIN COUNTY Ordinance Codes and/or Standards and State and/or Federal Laws. APPLICANT'S SIGNATURE: Date - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PR Records to be TRANSFERED: x $20.00 = Amount Paid Date Water System to be TRANSFERED: x $150.00 = Amount Paid Date Payment Type Check # Recvd by REHS or COUNTER SUPV Date / / ACCT out: Date / UNIT/File: PO Q y tf- IWMI Yom"